Anesthesia

After effects of anesthesia

06/07/2006

Question:

I had two surgeries within two months, The first was a rib resection for Thoracic Outlet Sydrome on January 30,2006. The second was on March 30, 2006, to repair two ruptured discs in my neck (C5/6 and C6/7). I seem to be experiencing some aphasia, memory problems, and concentration issues that were not present prior to these surgeries. I am a 47 year female in overall good health, although I am about 40 lbs.overweight. I am active and work full time as the Director of a Mental Health agency. I returned to work full time on April 30, 2006 and have really noticed the above sx and just not feeling as "sharp" mentally. Could my sx be a result of these two surgeries and related anesthesia? As far as I know both surgeries went fine with no complications. The rib resection was a much longer recovery time.

Answer:

Thanks for your question. The official terminology is "postoperative cognitive dysfunction" or POCD. A study from Denmark in the late 90s showed that this phenomenon is perhaps more common than we have previously thought, at least in elderly patients (over 60). About 25% of patients had cognitive deficits 1 week after major non-cardiac surgery. This decreased to about 10% after 3 months - still pretty high. This study triggered renewed interest into what, up until then, may have been thought of as something supported only by anecdotes, not scientific study.

In this study, a second operation was a risk factor for early, but not late (3 months) cognitive dysfunction. The study was done in elderly patients. Someone of your youth would be expected to have less of a problem with POCD but there isn't a whole lot of study data to document this.

The obvious conclusion is that general anesthesia, whose target, after all, is the brain, causes this impairment of brain function. The surprising thing is that regional anesthesia and general anesthesia are associated with about the same number of problems. In fact, one study showed a higher incidence of problems with regional (epidural) anesthesia. The difficulty with this area of study is that surgery cannot be performed without anesthesia, so you can't really separate out the effects of surgery and the recovery process, from the effects of anesthesia. No-one is volunteering to have surgery without anesthesia to help answer the research question!

The encouraging thing is that the studies seem to show most patients improve for at least 3 months and probably longer, so you still have a ways to go. Of course, many things other than your recovery from the surgery can affect mental sharpness. Are you getting enough sleep? Eating right? Have support at home? Do you smoke? Are you in pain? It's going to be stressful going back to a busy job after only a month of recuperation so psychological factors may also come into play.

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